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Dizziness – Vestibular Rehabilitation/Vertigo

Issues with balance and dizziness may occur at any age.  For some individuals balance disorders include a feeling of unsteadiness while others may experience the whole room spinning around them.  Dizziness/balance disorders may lead to fatigue, difficulty walking, depression or disinterest in daily activities. Dizziness/vertigo is not uncommon with one in three people experiencing dizziness or balance issues during their lifetime.


Your balance system consists of three sensory inputs to maintain proper balance.  These are touch/joint positioning (feet and ankles), sight (eyes) and vestibular (inner ear system).  The input to the brain from the sensory inputs interact, which then drives and controls our motor functions.  Given the complexity of the balance system, diagnosing dizziness or balance problems can be difficult at times.


These conditions can benefit from vestibular rehabilitation therapy:

  • Benign paroxysmal positional vertigo (BPPV)
  • Otolith dysfunction
  • Vestibular labyrinitis
  • Meniere’s syndrome


A vestibular rehabilitation program is designed to address balance, dizziness and overall fitness.  Patient education is stressed to facilitate patient understanding of what we are trying to accomplish with their individualized program.


Vestibular rehabilitation therapy is typically described as a therapist-directed, patient-motivated home based exercise protocol.  The exercises are graduated, beginning at the minimal skill level that the patient is capable of performing.  The exercise complexity is increased as compensation and habituation occur.  Patients have regular follow-up appointments with the therapist until optimal balance is achieved.


At the initial appointment, functional abilities such as gait, ambulation with head movement, balance with altered sensory cues and balance under static (sitting, standing) and dynamic conditions is assessed.  The therapist will collect a medical history including documentation of the type and intensity of symptoms and their effect on activities of daily living and previous treatments for the problem.  The assessment will use different measures to identify the type and severity of symptoms.


These may include:

  • Eye movement and vision assessment.  These tests address how well the person’s eyes move by themselves (such as when tracking a moving object without moving the head) and how the eyes move when the head is also moving.
  • Vertigo assessment.  A dizziness questionnaire helps to identify the frequency and severity of symptoms and any associate lifestyle changes.  The patient may be asked to move in and out of different positions requiring head and trunk motion in specific planes of motion and then report the presence and intensity of dizziness symptoms.
  • Balance and gait assessment.  Several tests will be used to assess balance and gait function and to compare balance function relative to that of others in the person’s age group.


Based on the assessment, the therapist generates a list of problems to treat; short and long term goals are established; and an individualized exercise program is developed.  The vestibular rehabilitation therapy program focuses on decreasing dizziness and visual problems, improving balance and walking function and increasing overall activity levels, essential for long-term retention of gains made in therapy.


The exercises are not difficult to learn, but that doesn’t mean they will be easy to do.  Some exercises may at first make your symptoms seem worse.  But with time and consistent work, your symptoms will steadily improve and you will find that you are able to participate more in your usual activities.  Exercises are performed daily at home and the regimen is updated during weekly outpatient visits with the therapist until the desire treatment goals have been achieved.  Therapy may last four to six weeks.